Texas isn’t the ‘worst,’ but moms are still dying

1of2In the U.S., two or three women die daily from complications of pregnancy or childbirth and the rate of maternal death for African-American women is four times that of white women.Photo: BOB OWEN, rowen@express-news.net / Express-News file photo

2of2Demonstrators for women's health care issues approach the Texas governor's office during the the special session on July 26, 2017.Photo: Tom Reel, Staff / San Antonio Express-News

It’s good news that Texas’ maternal mortality rate is much lower than previously believed, allowing the Lone Star State to shed the shameful, and apparently erroneously bestowed, distinction of having one of the highest rates in the world.

The bad news is that women are still dying.

That fact is not changed by a study this week blaming much of the alarming spike in pregnancy-related deaths in the pivotal year of 2012 on data errors.

Several of the state’s top health experts concluded in the report, published in the journal Obstetrics & Gynecology, that an enhanced way of counting the deaths using multiple sources shows the number of women who died in 2012 was actually 56, not 147.

Experts had been concerned about bad data for a while, so it’s good that we have some more reliable numbers and accurate picture of the problem.

Still, the picture is from 2012. There are still many questions and the need to assess data from more recent years to determine the situation today.

But we can’t let a bit of good news kill the motivation that has been building to address a problem that can still be described as bad for the state of Texas.

“I would hate to see us lose the momentum that we’ve gained,” said Dr. Lisa Hollier, an obstetrician and gynecologist at Texas Children’s Hospital.

“We still have women dying of preventable causes,” she said. “We still have a two-fold, a doubling, in the risk of death for African-American women. Those things need to change. I don’t think we should accept where we are.”

Hollier, who co-authored this week’s report and also chairs the Texas Maternal Mortality and Morbidity Task Force, points out that deaths aren’t the only measure of the problem. For every maternal death, Hollier says there are 50 women who experience severe complications that can lead to hysterectomies, breathing problems requiring ventilator support and kidney failure, to name a few.

“If there are 50 women who die in a particular year, there are 2,500 women who had severe complications,” Hollier said. “There are so many more women who are affected than just that tiny tip of the iceberg which is mortality.”

Hollier seemed confident that the lawmakers, physicians and representatives from medical societies she had spoken with since the report came out remain supportive of improving health access and outcomes for women.

“Everyone is still behind the movement to make motherhood safer,” she said.

Forgive me if I’m not so sure. In Texas, a state whose only motivation to reform bad policy seems to be high-profile crises drawing national media coverage and scathing federal court rulings, I’m worried that when the glare of the national spotlight fades, so will the attention on women’s health and maternal deaths.

“I have grave concerns,” agreed state Rep. Armando Walle, D-Houston, who has spearheaded efforts to address the issue. “I don’t want this report to be used as a distraction not to fund the necessary programs that allow women access to providers and to deal with postpartum depression.”

Walle said he is encouraged by local efforts involving Houston Endowment Inc., nonprofits and elected officials to remain focused on the issue.

“Every medical professional I’ve spoken to acknowledges that there’s a problem,” he said. “There’s bipartisan consensus to do something in the next couple of sessions. Regardless of what this report says … I’m going to move forward with legislation that we’re going to carry next session.”

Several of his priorities are common-sense policies that Hollier supports as well.

One, of course, is the perennial issue of increasing women’s access to primary and preventative care in a state that refused to expand Medicaid under Obamacare, and where women’s health programs have been decimated by deep funding cuts and the politically motivated extraction of what had been the state’s largest and most experienced provider, Planned Parenthood.

The state sacrificed millions of federal matching dollars to kick out Planned Parenthood because some of its clinics provide abortions. And studies have shown women have paid the price with loss of access to quality care and family planning services.

Hollier supports extending Texas women’s Medicaid eligibility for a year postpartum. As it is now, many women lose Medicaid coverage 60 days after giving birth. The state health agency says it has begun allowing women to enroll in the state program, but Hollier worries about paperwork and bureaucratic hurdles that disrupt continuity in a new mother’s care.

Another priority for Hollier is creating a culture of safety in hospitals. That involves, in part, promoting a set of evidence-based practices that can help hospitals more successfully deal with problems that can arise for pregnant women, such as hemorrhage. Hospitals that embrace protocols known as “patient safety bundles” learn the best way to teach staff to look for warning signs of a problem, respond to it and report outcomes to measure their progress.

The Texas Department of State Health Services has joined an alliance of health organizations promoting this approach and is encouraging hospitals around the state to participate, Hollier said.

It’s encouraging, but as regulation goes in Texas, it’s voluntary. Hospitals, if they wish, are free to stick to outdated practices that do nothing to reduce risk of maternal deaths.

The last, and perhaps most important, priority Hollier mentioned is for women to become their own advocates, to ask questions of nurses and doctors about their care, and if the situation arises, to assert themselves the way tennis star Serena Williams says she did during the birth of her daughter.

The state has a stake in saving women’s lives that goes far beyond saving the state’s reputation. The problem of Texas women dying before, during and after childbirth may not, in fact, be as bad as we thought.

But here’s another fact Texans should keep in mind as we demand better, safer, more accessible care for women: even one preventable death of a Texas mother is too many.

Lisa Falkenberg is the Chronicle’s vice president/editor of opinion. A Pulitzer Prize-winning journalist with more than 20 years’ experience, Falkenberg leads the editorial board and the paper’s opinion and outlook sections, including letters, op-eds and Gray Matters.

Falkenberg wrote a metro column at the Chronicle for more than a decade that explored a range of topics, including education, criminal justice and state, local and national politics. In 2015, Falkenberg was awarded the Pulitzer for commentary, as well as the American Society of News Editors’ Mike Royko Award for Commentary/Column Writing for a series that exposed a wrongful conviction in a death case and led Texas lawmakers to reform the grand jury system. She was a Pulitzer finalist in 2014.

Raised in Seguin, Texas, Falkenberg is the daughter of a truck driver and a homemaker, and the first in her family to go to college. She earned a journalism degree from the University of Texas at Austin in 2000. She started her career at The Associated Press, working in the Austin and Dallas bureaus. In 2004, Falkenberg was named Texas AP Writer of the Year.

She joined the Chronicle in 2007 as a roving state correspondent based in Austin.

Falkenberg has mentored journalism students through the Chronicle’s high school journalism program and volunteered with the News Literacy Project. She is a fellow with the British-American Project and has completed a fellowship at Loyola’s Journalist Law School in Los Angeles.